The Impact of Childhood Household Violence on HIV-Related Outcomes in People With HIV in the United States: The Role of Psychological Distress and Social Stressors

Background: Psychological distress (eg, depression) and social stressors (eg, HIV-related stigma) can affect HIV-related outcomes such as antiretroviral therapy adherence and health-related quality of life (HRQL). Limited research on adverse childhood experiences such as childhood household violence (CHV) has shown a similar impact on HIV-related outcomes, particularly virologic suppression, although little is known about mediating pathways with factors such as psychological distress and social stressors. Setting: Data from the Centers for AIDS Research Network of Integrated Clinical Systems cohort were analyzed. This article examines the relationship between CHV and HIV-related outcomes, and potential differences between those with and without CHV by age (<50 vs. ≥50 years). Methods: Bivariate comparisons, linear regressions, and mediation analyses between CHV and other variables were used to assess association with outcome measures. Results: Among 7705 people with HIV, CHV was reported by 19% (n = 1498). CHV was associated with lower antiretroviral therapy adherence ( P < 0.001), more HIV symptoms ( P < 0.001), and lower HRQL ( P < 0.001). In addition, CHV exposure was associated with worse depressive symptoms ( P < 0.001), increased panic symptoms ( P < 0.001), lower social support ( P < 0.001), greater self-report of HIV stigma ( P < 0.001), and more exposure to intimate partner violence ( P < 0.001). Psychological distress and social stressors mediated the relationship between CHV and adherence, HIV symptoms, and HRQL, with depressive and panic symptoms accounting for the greatest proportion mediated. Conclusions: CHV has an adverse impact on social and psychological factors in adulthood for people with HIV. Depressive symptoms and panic symptoms are potential targets for interventions.